Neurosurgeon + orthopedic surgeon = A team approach to back fusion surgery

“When I trained at Rush University Medical Center, we performed our lumbar fusion procedures with orthopedic surgeons, so for me, it's not a novel concept—that's what I was exposed to during my residency,” she explains.

Why would a neurosurgeon and an orthopedic surgeon operate together?

“Teaming a neurosurgeon and an orthopedic surgeon is a great collaboration because we are fundamentally very different in our skills,” says Dr. Foroohar. “I'm somebody who does brain surgery, so I'm very microsurgical in my technique and am very comfortable operating close to the nerve.

“Back surgery can involve hardware, and no one understands hardware and putting in screws better than orthopedic surgeons,” she adds. “Everything they do, whether it's joint replacement or fixing a fracture, involves hardware. So there's a lot to be gained from neurosurgeons working with orthopedic surgeons. You obtain a much better understanding of hardware—I myself have learned so much about spine biomechanics.”

How do you perform spinal fusions with the orthopedic surgeon?

“In some surgical settings, the neurosurgeon would perform the decompression, meaning freeing the nerve, and the orthopedic surgeon would place the hardware,” Dr. Foroohar explains. “But Dr. Mannion and I are trained in both procedures, so he does the decompression and the screws on one side of the spine, and I do them on the other side.”

“When Dr. Foroohar is working, I'm watching her carefully,” says Dr. Mannion. “And when I'm working, she's watching me carefully. This has an additional benefit that is hard to quantify; it's invaluable to have that second set of eyes and hands and ears working toward a common goal.”

How are a neurosurgeon's and an orthopedic surgeon's perspectives different?

“When neurosurgeons think of the spinal disorders, we focus on nerve compression,” says Dr. Foroohar. “The other component of spine is the biomechanics—the conceptual framework of the orthopedic surgeon.

“Some patients may have scoliosis, a deformity or curvature of the spine, or spondylolisthesis, slippage in the spine,” she explains. “We always think of surgical results in terms of biomechanics and stability in addition to nerve decompression.”

“The kinds of cases Dr. Foroohar and I focus on doing together are those where a patient has instability in the spine,” says Dr. Mannion.

How do patients benefit when a neurosurgeon and an orthopedic surgeon team up?

“We think our patients do really well with this team approach,” says Dr. Foroohar. “You're having a neurosurgeon and an orthopedic surgeon—essentially two spine surgeons with different backgrounds—offering you the best of our service.”

Dr. Mannion adds, “We think that operating together is good for our patients because it leads to:

Fewer complications

Shorter hospital stays

Better outcomes

“This is our vocation in life,” he explains. “Dr. Foroohar and I have agreed to try to take care of our patients and to help them. Everything else is secondary.”

“The collaboration between neurosurgeons and orthopedic surgeons is unique,” says Dr. Foroohar. “I think the end result is much better than that of surgeons who perform lumbar fusion surgery by themselves.”

How do patients feel about neurosurgeons and orthopedic surgeons collaborating?

“Patients always love it,” says Dr. Mannion. “It's more a question of making sure we can schedule a time when Dr. Foroohar and I can do cases together. Once patients have been told they can have both of us operating together, they won't do it any other way.”

How long have you been operating together?

“Dr. Foroohar and I have been collaborating since 2001,” says Dr. Mannion. “We work very well together—we're a good team. And that extends to the other team members in our operating room. All of them have worked with us for a long time; in all the years I've worked with Dr. Foroohar, we've had pretty much the same personnel in the operating room.

“We are able to draw a very experienced team who also likes our approach and requests to be in our operating room,” he adds. “Our team includes an anesthesiologist, a scrub tech or scrub nurse and two circulating nurses.”

“Most neurosurgeons and orthopedic surgeons do not tend to collaborate since it does result in splitting the surgical fee,” Dr. Foroohar explains. “Dr. Mannion and I are both there for the entire procedure—but we're getting paid half of what we would have gotten if we had done the surgery by ourselves.”